Planning a pregnancy with type 1 or 2 diabetes

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If you have type 1 or 2 diabetes, it is very important to talk to your healthcare team if you are thinking about having a baby. There are some things that are best done before you get pregnant that will reduce your risk of pregnancy complications and baby loss.

Why it’s so important to plan my pregnancy?

If you have type 1 or 2 diabetes, you need to be as healthy as possible before you conceive, and while you are pregnant. All pregnancies come with risks, but if you have type 1 or 2 diabetes, your level of risk is higher, for the baby and for you. You can’t avoid these risks completely, but there are a lot of things you can do to reduce them.

Preparing for pregnancy with type 1 or 2 diabetes

You should get information about how diabetes affects pregnancy and how pregnancy affects diabetes. You will also be given details of local support you can have during pregnancy, including emergency contact numbers.

Having diabetes should not affect your fertility (your ability to get pregnant). Talk to your doctor if you have any concerns about your fertility.

There are several steps you can take before getting pregnant that will give you the best possible chance of having a healthy pregnancy.

Step 1 Get your HbA1C to the recommended level

Your HbA1C gives your average blood glucose level for the previous 2-3 months. The closer it is to your ideal level, the lower the risk of miscarriage or stillbirth. Your healthcare team will be able to tell you what this level is for you; it is likely to be below 48 mmol/mol (6.5%).

If your levels are too far above the ideal level, your team will encourage you to manage your blood glucose more tightly before you get pregnant. You will have your HbA1C tested every month until you reach the recommended levels.

If your HbA1C is very high (above 86 mmol/mol or 10%) you are strongly recommended to avoid getting pregnant until you can reduce the levels. This will reduce the risk of miscarriage, and of your baby dying before, during or after they are born.

Step 2 Check your blood glucose levels

It’s important to get glucose levels in control before conception because the first eight weeks of pregnancy are especially important for your baby’s development. You are unlikely to know that you’re pregnant for the first few weeks. So, it is best to use contraception until you’ve established good blood glucose levels.

While you are getting ready to conceive, you need to start managing your blood glucose much more. It can help to check your blood sugars much more often than usual so that you really understand how your diabetes affects you. This includes testing your levels before after meals. Your healthcare team will talk to you about your blood glucose targets and controlling these during pregnancy.

Step 3 Take a higher dose of folic acid

All women planning to become pregnant are recommended to take folic acid to help prevent birth defects, such as spina bifida. If you have diabetes you are at higher risk of having babies with these disorders, so you should take a higher dose of folic acid (5mg per day). This higher dose can only be prescribed by your doctor because it isn't available over the counter.

Taking folic acid at least 2 months before conception can reduce the risk of birth defects by more than 70%. Because you will not know immediately when you become pregnant, the best thing to do it take folic acid 2 months before you stop taking contraception. Speak to your doctor about your folic acid intake if it is taking longer for you to get pregnant.

Once pregnant you should continue taking folic acid until you are 12 weeks into your pregnancy.

Don’t worry if you have become pregnant without taking folic acid. Many women have been in this situation and their babies have been healthy.

Step 4 Check your medication

Check with your team that any medication for treating diabetes (including insulin) and for complications of diabetes, is suitable to take during pregnancy. Metformin is safe, but you need to stop any other glucose-lowering tablets before you get pregnant or as soon as you realise you are pregnant.

Some other prescribed medications, such as statins, should also be stopped.

You will also need to talk to your doctor if you are taking other injected medications often used for type 2 diabetes, such as Victoza (liraglutide) and Byetta (exenatide) or similar. These are unsafe in pregnancy.

But don’t stop taking any prescribed medications before speaking to your healthcare professional.

Pregnancy can change how your body uses glucose, so your treatments for diabetes may need to change. If you have Type 2 diabetes and are on tablets, you may move to insulin injections. If you are on injections but you are still struggling to control your levels, you may be offered insulin pump therapy. Your diabetes team will give you more information.

Step 5 Have your eyes and kidneys checked

Get an overall health check from your GP or diabetes team – especially your eyes and kidneys – to make sure there aren’t any concerns. If there are concerns, you may be referred to a specialist team for follow up. Pregnancy puts extra pressure on the blood vessels in these areas, which are already at risk if you have diabetes so your checks will be repeated through pregnancy, usually once every trimester.

Don’t stop using contraception until you have received your renal (kidney) assessment and any treatment that you need.

Step 6 Look at your lifestyle

There are things you can do to improve your general health and prepare your body for pregnancy. This includes:

If you have a body mass index (BMI) above 27, your healthcare team should give you advice on how to lose weight. If you are already pregnant, you shouldn’t diet as this may be unsafe for you and your baby. However, if you were overweight before pregnancy, healthy changes to your diet and lifestyle will help you to manage your weight in pregnancy.

Step 7 Check that you're vaccinated

Like everyone, you need to check that you have had your rubella or MMR injection if you have never had rubella. If you aren’t sure, ask your GP who may have a record of previous vaccinations. If your GP can't tell you, book a vaccination now. It doesn't make a difference of you have already had it and it will put your mind at ease. Read more about rubella and planning a pregnancy here.

What else do I need to be aware of?

Equipment for testing

If you have Type 1 diabetes, you should be given a blood ketone meter and testing strips. You can use these to test for ketones if your blood glucose levels are too high or you become unwell. Get medical advice immediately if your ketone readings are high.

Flash Glucose Monitors and CGM monitors are also available to track your blood glucose levels.

Metformin

Even though the patient information leaflet for Metformin advises that Metformin shouldn’t be used when planning to become pregnant and during pregnancy, there is strong evidence that it is safe. Metformin is commonly used in the UK for managing diabetes during pregnancy and breastfeeding.

The National Institute for Health and Care Excellence (NICE) and the Scottish Intercollegiate Guidelines Network (SIGN) both endorse Metformin for use in pregnancy.

Speak to your healthcare professional if you have any questions or concerns.

Before changing your blood glucose levels

If you are planning to make a rapid change to your blood glucose levels before you get pregnant, wait until you have had your eye examination and any resulting treatment. Rapid improvement in blood glucose control can sometimes make diabetes eye problems (retinopathy) worse.

Rubella is rare but it can be dangerous to the unborn baby if you catch it while you’re pregnant. You can prevent this by making sure you have the MMR vaccination (jab), which includes rubella, before you start trying for a baby.